Perinatal management of common neonatal thoracic lesions

Abstract

Esophageal atresia, congenital diaphragmatic hernia, bronchopulmonary malformations and cystic lung diseases are the common neonatal thoracic surgical lesions encountered in practice. The availability of antenatal ultrasonography has lead to these lesions being detected before birth. Antenatal diagnosis can be made with a fair degree of accuracy in tertiary fetal medicine centres. Antenatal intervention is limited in a very few centres in the western world and not being done in India at present. The outcome of these babies with antenatal diagnosis of thoracic lesions has changed in the last decade. Earlier intervention is now possible in cystic lung disease before infectious complication has set in. All these lesions are managed exclusively in well developed neonatal surgery units with excellent outcome in the western world. The present study reviews the antenatal detection, clinical presentation, interventional/surgical procedures [antenatally and postnatally] and outcome of these common neonatal thoracic surgical lesions.

Prenatal Diagnosis and Postnatal Findings of Bronchogenic Cyst

“…In case of intraparenchymal bronchogenic cysts wedge resection, segmental resection, or lobectomy may be required. The long-term outcome for infants and children with bronchogenic cysts is excellent because they generally do not require sacrifice of significant normal lung parenchyma [2]. In our case, the child had a good prognosis after the surgery because the congenital lung lesion was unique and there were no other complication signals in the chest CT. …”

“…The prenatal diagnosis of bronchogenic cyst is very important because, depending on the size, the cyst can compress the normal lung parenchyma causing pulmonary hypoplasia or compress the heart causing hydrops and fetal death [2]. Levine et al [5] described a case of progressive fetal bronchial obstruction caused by a bronchogenic cyst diagnosed by magnetic resonance imaging (MRI).…”

“…The cyst wall has structural elements of the air way including cartilage, smooth muscle, mucous glands, and respiratory epithelium. Malignancies have been reported in these lesions [2]. …”

Subcutaneous bronchogenic cyst of the chest wall: A case report with brief literature review

“…Bronchogenic cysts are non-malignant congenital anomalies of the primordial ventral foregut. The cyst wall contains structural characteristics of the airway such as cartilage, smooth muscle, mucous glands, and respiratory epithelium [9] , [10] . They are most commonly found intra-thoracic and are classified as mediastinal or parenchymal, depending on where they are found.…”

Angeborene pulmonale Malformationen

“…In 15 % der Fälle werden aber auch intrapulmonale Befunde gesehen. Dann kann die Abgrenzung zur CPAM schwierig sein [35].…”